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However, not everyone converts synthetic forms efficiently, particularly those with higher metabolic stress, liver strain, or certain genetic variations including the MTHFR mutation

Response: As previously discussed in this final rule with comment period, we believe the payer-specific negotiated charges would better reflect relative resources used because the rates that hospitals negotiate with MAOs capture the relative resource use to provide services to patients in order to maximize profits (or, in the case of not-for-profit hospitals, net income), subject to market constraints and conditions (supply and demand, community benefit requirements, etc.)

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It should be administered under medical supervision